Being Humorous & Seeking Diversion: Promoting Healthy Coping Skills among LGBTQ+ Youth

Abstract

LGBTQ + youth encounter pervasive stigma-related stress that requires effective coping skills. This study explored the coping patterns of LGBTQ+ youth participants (N = 30) in a cognitive-behavioral therapy based coping skills training. Participants, 15–18 years old with a range of gender, sexual, racial and ethnic identities, completed a coping skills inventory (A-COPE) with 12 subscales at two time points. Based on the stigma-coping framework, coping skills were broadly classified as disengagement or engagement strategies. LGBTQ+ youth were most likely to utilize avoiding problems as a strategy to cope with stress, followed closely by being humorous, relaxing and ventilating feelings. Notably, seeking professional and spiritual support were the least adopted coping strategies. Post intervention, participants reported significant increases in the areas of primary control (solving family problems) and secondary control (seeking spiritual support, seeking diversion, engaging in demanding activities and being humorous). The findings demonstrate the versatility of LGBTQ+ youth's coping strategies and show the potential of the AFFIRM intervention to promote engagement coping patterns among this population.

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Journal of Gay & Lesbian Mental Health
ISSN: 1935-9705 (Print) 1935-9713 (Online) Journal homepage: http://www.tandfonline.com/loi/wglm20
Being humorous and seeking diversion: Promoting
healthy coping skills among LGBTQ+ youth
Shelley L. Craig, Ashley Austin & Yu-Te Huang
To cite this article: Shelley L. Craig, Ashley Austin & Yu-Te Huang (2018) Being humorous
and seeking diversion: Promoting healthy coping skills among LGBTQ+ youth, Journal of Gay &
Lesbian Mental Health, 22:1, 20-35, DOI: 10.1080/19359705.2017.1385559
To link to this article: https://doi.org/10.1080/19359705.2017.1385559
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Oct 2017.
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JOURNAL OF GAY & LESBIAN MENTAL HEALTH
, VOL. , NO. , –
https://doi.org/./..
Being humorous and seeking diversion: Promoting healthy
coping skills among LGBTQ+youth
Shelley L. Craig, PhD, LCSW a, Ashley Austin, PhD, LCSWb, and Yu-Te Huang, PhDc
aFactor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada; bSchool of Social Work,
Barry University, Miami Shores, Florida, USA; cDepartment of Social Work and Social Administration, The
University of Hong Kong, Pok Fu Lam, Hong Kong
ARTICLE HISTORY
Received  April 
Revised  September 
Accepted  September 
KEYWORDS
Affirmative therapy; coping;
group therapy; youth
ABSTRACT
LGBTQ +youth encounter pervasive stigma-related stress that
requires eective coping skills. This study explored the coping
patterns of LGBTQ+youth participants (N=30) in a cognitive-
behavioral therapy-based coping skills training. Participants,
15–18 years old with a range of gender, sexual, racial and ethnic
identities, completed a coping skills inventory (A-COPE) with
12 subscales at two time points. Based on the stigma-coping
framework, coping skills were broadly classied as disengage-
ment or engagement strategies. LGBTQ+youth were most likely
to utilize avoiding problems as a strategy to cope with stress,
followed closely by being humorous, relaxing, and ventilating
feelings. Notably, seeking professional and spiritual support
were the least adopted coping strategies. Post-intervention,
participants reported signicant increases in the areas of primary
control (solving family problems) and secondary control (seeking
spiritual support, seeking diversion, engaging in demanding
activities, and being humorous). The ndings demonstrate the
versatility of LGBTQ+youth’s coping strategies and show the
potential of the AFFIRM intervention to promote engagement
coping patterns among this population.
LGBTQ +youth experience pervasive stigma-related stress. Although adolescence
is often a period of developmental turmoil (e.g., school pressure, home life, peer and
romantic relationships, and future uncertainty) for a vast majority of youth (Byrne,
Davenport, & Mazanov, 2007;Caseyetal.,2011), LGBTQ+youth are exposed to
pronounced health and psychosocial risks as a result of discrimination based on
their sexual orientation or gender identity (Almeida, Johnson, Corliss, Molnar, &
Azrael, 2009). Minority stress, a form of stigma-related stress, which aects those
who are part of a socially devalued group (Meyer, 1995;Miller&Kaiser,2001), is
particularly troubling for LGBTQ+youth. Minority stress contributes to an indi-
vidual’s expectation of rejection, internalized homo-/transphobia, and concealment
(Alessi, 2014;Meyer,1995,2003). Moreover, minority stressors can translate into
CONTACT Shelley L. Craig, Ph.D, LCSW shelley.craig@utoronto.ca University of Toronto, Factor-Inwentash
Faculty of Work  Bloor St. W., Toronto, ON MS V, Canada.
©  Taylor & FrancisGroup, LLC

JOURNAL OF GAY & LESBIAN MENTAL HEALTH 21
structural barriers for LGBTQ+youth’s educational and vocational opportunities
(Barrett, Pollack, & Tilden, 2002; Pearson & Wilkinson, 2017) and access to social
and mental health services (Burgess, Lee, Tran, & van Ryn, 2008). Hatzenbuehler
(2009) posits that general psychological processes and stigma-related stress can
interact and mutually reinforce one another. These interactions negatively aect
LGBTQ+’s mental health through a psychosocial pathway from stigmatized iden-
tity to mental health disparities such as depression, anxiety, and substance use.
Cumulative stressors among LGBTQ+youth, such as stigmatization, rejection, and
mental health concerns (Craig & McInroy, 2013), may require particular coping
strategies(Miller&Major,2000). The existent literature generally agrees that “cop-
ing resources” are important to health outcomes (Hunter, 1999; Perrin et al., 2004;
Safren & Heimberg, 1999), yet there is a paucity of empirical research examining
the strategies LGBTQ+youth employ to cope with discrimination and minority
stressors (McDavitt et al., 2008). The purpose of this research is to describe the
coping strategies utilized by a community-based sample of LGBTQ+youth and to
evaluate the eect of a cognitive-behavioral therapy intervention on augmenting
LGBTQ+youth coping capacity.
Coping and LGBTQ+youth
Coping, dynamic and conscious actions to regulate behavior in the face of stress,
is critical to adolescent health and well-being (Compas, Connor-Smith, Saltzman,
Thomsen, & Wadsworth, 2001). In their seminal work, Lazarus and Folkman (1984)
postulate that the coping process consists of rapidly adjusting eorts to balance
between demands and one’s abilities or resources to tackle these demands. The
appraisalofthedemandsofstressandresourcesaectsthetypesofcopingstrategies
that are employed. Coping strategies are generally dierentiated between problem-
focused approaches, purposeful intentions to resolve tensions between the self and
the environment, and emotion-focused approaches aimed at mitigating negative
emotion invoked by stress (Compas et al., 2001).Themoremanageablestressis
appraisedtobe,themoreinclinedanindividualistoadoptproblem-focusedcoping
(Billings & Moos, 1984;Evansetal.,2015). Compared to emotion-focused approach,
problem-focused coping is found to be more eective in reducing psychological dis-
tress (Billings & Moos, 1984;Evansetal.,2015;Lewis&Frydenberg,2002). Con-
versely, emotion-focused strategies such as acting out, withdrawal, and avoidance
may allow for temporary relief of negative emotion, but usually do little to address
the root causes of stress (Blechman & Vryan, 2000).
Coping-competence and stigma-coping theories and LGBTQ+youth
Two theories can inform our understanding of the relationship between stress
and coping for LGBTQ+youth. According to coping-competence theory, the
negative eects of stress on mental health are partly dependent on the coping
strategies employed (Blechman, 1997;Compasetal.,2001). For example, in a

22 S. L. CRAIG ET AL.
study of LGBTQ+youth (n=423), negative coping strategies (e.g., internalization,
detachment, and substance use) have been identied as mediators between het-
erosexist discrimination and posttraumatic stress symptoms (Bandermann &
Szymanski, 2014). Similar outcomes were found in a study of gay and bisexual men
(Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2009). Miller and Kaiser (2001)
propose a stigma-coping framework which categorizes coping with stigma-related
stress into two broad types—engagement and disengagement coping—which
are akin to the notions of “ght” or “ight.” Viewed as inherently avoidant,
disengagement coping is employed to minimize the opportunities to encounter
stress or be confronted with stigma by keeping distance from challenging situa-
tions. On the contrary, engagement coping is active in its goal for an individual to
obtain control over stressful situations. In a recent study of children and youth (n
=227), Evans et al. (2015) found that stressful life events predicted depression.
Further, more use of disengagement and less use of engagement coping strategies
in turn contributed to heightened depressive symptoms for participants.
Engagement coping
Several studies have highlighted the importance of engagement coping for LGBTQ+
populations. Young gay men in McDavitt et al.’s (2008) study stated that when an
experience of heterosexism provoked an intense emotional reaction, they would
utilize four types of engagement coping strategies: (1) situational modication (e.g.,
avoiding the topic of sexual orientation, telling half-truths, keeping a low prole
or avoiding heterosexist environments, concealing sexual orientation, seeking ar-
mative situations, and educating others); (2) attentional deployment (e.g., paying
partial attention to a stigmatizing environment and/or dismissing provocations that
target their sexual minority status); (3) cognitive changes (e.g., reframing others’
heterosexist attitudes, deconstructing the heterosexist assumptions, and reclaiming
their sense of self-reliance); and (4) response modulation (e.g., one’s attempt to
transform emotion after it has been evoked, such as venting feelings, suppression,
and even substance use). Importantly, McDavitt et al.’s (2008)studyfoundthat
LGBTQ+youth employed a range of strategies depending on the stigmatizing
situation and their level of distress. Primary control coping strategies such as
emotion regulation—the management of self before, during, and after an emo-
tional reaction (Gross, 1998)—can enable LGBTQ+youth to eectively manage
stigma-related stress (Hatzenbuehler, 2009;Miller&Kaiser,2001)andhavebecome
acriticaltargetofpreventionforLGBTQ+youth (Hatzenbuehler, McLaughlin, &
Nolen-Hoeksema, 2008). In a study of multiethnic sexual minorities, Choi, Han,
Paul, and Ayala (2011) found that the participants used emotional regulation as
a strategic coping strategy as they managed discrimination and avoided rejection
from their cultural communities. Excessive rumination and decit in emotion
regulation can also account for the higher rate of depression and anxiety reported
by LGBTQ+youth than heterosexual peers (Hatzenbuehler et al., 2008). Engage-
ment coping can be further broken down into primary and secondary control
coping. While primary control is aimed at proactively altering the stressful situation

JOURNAL OF GAY & LESBIAN MENTAL HEALTH 23
by means of problem solving (e.g., initiating LGBT empowerment campaigns),
emotional regulation (e.g., regulating one’s anger or resentment), and emotional
expression (e.g., expressing the feeling of frustration to friends), secondary con-
trol reects an individual’s attempt to adapt to stigma-related pressure through
distraction (e.g., engaging in recreation), cognitive restructuring (e.g., transform-
ing the unpleasant feeling to ambition to achieve success), and acceptance (e.g.,
acknowledging the prevalence of homo/transphobia).
Disengagement coping
Disengagement coping is dened as a passive or hazardous form of coping that
often precipitates internalized and externalized problems (see Compas et al., 2001,
for review). For example, self-destructive behavior, such as cutting, self-hitting, and
burning, is correlated with adolescents’ use of avoidant coping (Evans, Hawton, &
Rodham, 2005),andhasbeenknowntobeusedinresponsetoexperiencesofhomo-
phobic treatment (Fenaughty & Harre, 2003;Sornberger,Smith,Toste,&Heath,
2013). Sornberger et al. (2013) found that compared to their heterosexual peers,
bisexual and questioning youth reported greater engagement in non-suicidal self-
injury behavior (Miller & Kaiser, 2001). McDermott, Roen, and Scoureld (2008)
found that LGBTQ+youth engaged in self-destructive behavior to release their
emotional distress and avoid homophobic shaming. For example, the higher rates of
substance use among LGBTQ+youth (Marshal et al., 2008)havebeenobservedas
an approach to cope with discriminatory environments (Bandermann & Szymanski,
2014).
Disengagement strategies that are typically considered avoidant may work dif-
ferently for LGBTQ+youth. For example, the LGBTQ+youthinMcDavittetal.’s
(2008) study utilized seemingly avoidant strategies (e.g., avoiding encounters with
individuals who exhibited heterosexist attitudes) in an “active and calculated” man-
ner (p. 363) where avoidance was not used as a coping strategy of last resort, but
as a result of meticulous assessment of the risk inherent in situations that may be
fraught with discrimination. Due to the stigma that they often experience from fam-
ily members, LGBTQ+youth may carefully assess the risks and benets of attend-
ing a holiday dinner and choose to avoid that event. In addition, LGBTQ+youth
havebeenfoundtousethemedia,particularlytelevisionviewingandonlinesurng,
to “give space” from the discrimination they experience in their external environ-
ment (Craig, McInroy, McCready, & Alaggia, 2015). The Internet, for example, has
become a venue for LGBTQ+youth to obtain emotional and informational support,
as well as to access a safe and arming online community (Craig & McInroy, 2014;
McDavitt et al., 2008). Thus, although often conceptualized as disengagement for
general youth populations (van Ingen, Utz, & Toepoel, 2016), the use of information
communication technologies (ICTs) may benet LGBTQ+whose lived experiences
may include structural discrimination and exclusion in contexts (schools, families,
policies) that are dicult for them to change.
Although coping is theorized as a process or mediator/moderator of relationships
in research identifying on the health and mental health outcomes of adolescents

24 S. L. CRAIG ET AL.
(Franko, Thompson, Aenito, Barton, & Striegel-Moore, 2008;Garcia,2010), it
has been suggested that studies that measure coping as an primary outcome would
advance interventions with adolescents (Garcia, 2010). The stressors and health
disparities encountered by LGBTQ+youth necessitate interventions that focus on
understanding and modifying coping behaviors as well as social/structural stressors
(Hatzenbuehler, 2009). CBT and coping skill-based interventions, in which psycho-
logical distress and unhealthy behaviors are identied, evaluated, and altered, have
been found ecacious in enhancing LGBTQ+youthmentalhealthandcognitive
appraisal because they establish a permanent skill set to mediate current and future
stressors that impact health (Craig & Austin, 2016). Despite the emerging research
interest in the coping strategies of LGBTQ+populations, little research with youth
exists. To address these gaps, this study explored the coping strategies of LGBTQ+
youth, examined the utility of the Adolescent Coping Orientation for Problem
Experiences (A-COPE) measure for LGBTQ+youth, and evaluated the inuence
of an armative CBT-based coping skills intervention on the coping strategies of
LGBTQ+youth.
Method
Design
This exploratory study of an eight-module, armative coping skills-based group
intervention (AFFIRM) was conducted in a major urban area. An earlier pilot study
detailed the results of the mental health outcomes as well as ndings related to pre-
liminary feasibility (Craig & Austin, 2016). The primary aim of the current study
is to explore changes in the coping strategies of AFFIRM participants. Institutional
Research Board approval was obtained for the study.
Recruitment
LGBTQ+youth were recruited using purposive sampling through an active Com-
munity Advisory Board (consisting of community-based clinicians, researchers,
and youth) and online sources such as emails and a closed Facebook group. Study
inclusion criteria included: (1) youth aged 14–18 years (upon enrollment) who iden-
tify as non-heterosexual, transgender, or gender nonconforming; (2) able to com-
municate in English; and (3) agree to participate in an eight-module intervention.
Youth were individually screened for eligibility during a short telephone or text
interview and, if eligible, completed a pre-assessment prior to the intervention.
Informedconsentandparentalconsentor,ifnotpossible,assentwereobtained.
To minimize attrition, LGBTQ+received compensation of increasing value for
study participation (T1 for $20; T2 for $30). In an eort to increase engagement
and minimize attrition, participants also received meals, snacks, and transportation
vouchers.

JOURNAL OF GAY & LESBIAN MENTAL HEALTH 25
AFFIRM procedures
Developed through extensive community-based research (Austin & Craig, 2015a),
AFFIRM is an eight-module, manualized cognitive behavioral intervention created
to improve coping and reduce mental health distress. AFFIRM provides opportuni-
ties to understand and modify cognition (awareness of self and risk), mood (identi-
fying the link between thoughts and feelings), and behavior (recognizing strengths
and ways of coping) (Craig, Austin, & Alessi, 2013). During AFFIRM, skills were
identied and rehearsed within an armative context that validated youths’ iden-
tities and acknowledged stigma-based stressors. A local LGBT Community Center
provided an accessible, safe, and condential space to implement AFFIRM. Three
AFFIRM groups, each consisting of 10 youth, were conducted concurrently during
the intervention. Six co-facilitators, with experience working with LGBTQ+youth
and utilizing CBT, delivered the AFFIRM intervention. All facilitators received
approximately ve hours of training in delivering the AFFIRM intervention.
Sample
Participants (n=30) in the AFFIRM pilot intervention were between 15 and
18 years old (mean =17.07, SD =0.94) as no 14-year-olds were recruited. As noted
in Table 1 , demographic data (not mutually exclusive) included female (56.7%), male
(20%), transgender (6.7%), gender independent/non-binary (20%), and/or two-
spirit (3.3%). Sexual orientation ranged from pansexual (26.7%), lesbian (26.7%),
queer (20%), bisexual (16.7%), unsure/questioning (10%), gay (13.3%), polysexual
(6.7%), to asexual (3%). Race/ethnicity included predominately White European
Tab le  . Demographics of study participants (n=).
Variables Mean (SD) Number (Percentage)
Age . (.)
Gender
Female  (.)
Male  (.)
Tran s (.)
Non-binary gender  (.)
Two-spirit  (.)
Sexual orientation
Pansexual (.)
Lesbian  (.)
Queer  (.)
Bisexual (.)
Unsure/questioning  ()
Gay (.)
Polysexual (.)
Asexual  (.)
Race/ethnicity
White European  (.)
East/South/Southeast Asian  ()
Black/African/Caribbean  (.)
Indigenous/First Nations  (.)
Latino/a (.)

26 S. L. CRAIG ET AL.
(63.3%), followed by East/South/Southeast Asian (30%), Black/African/Caribbean
(26.7%), Indigenous/First Nations (26.7%), and/or Latino/a (6.7%).
Measures
Demographic measures of age, grade, gender identity, sexual orientation, and
race/ethnicity were collected at baseline. The Adolescent Coping Orientation for
Problem Experiences (A-COPE) was collected at baseline (T1) and immediately
after the intervention (T2). The A-COPE has been widely used in the coping lit-
erature as a comprehensive and reliable assessment of adolescents’ coping patterns
across emotional, behavioral, and cognitive domains (Garcia, 2010;Patterson&
McCubbin, 1987). For example, with a sample of 358 Palestinian adolescents, Tha-
bet, El Buhaisi, and Vostanis (2014) found sucient internal consistency of A-COPE
(Cronbach’s alpha =.84). The A-COPE has also been suggested as a tool to evalu-
ate the outcome of clinical interventions with adolescents (Blount et al., 2008), yet
we have not found any research that utilized the A-COPE with LGBTQ+youth.
The A-COPE contains 54 items that tap into 12 dierent coping domains (ventilat-
ing feelings, seeking diversions, developing self-reliance and optimism, developing
social support, solving family problems, avoiding problems, seeking spiritual sup-
port, investing in close friends, seeking professional support, engaging in demand-
ing activity, being humorous, and relaxing). Questions such as: “Try, on y our own, to
gureouthowtodealwithyourproblems”and“Trytostayawayfromhomeasmuch
as possible” are used. Response options ranged from 1 (never) to 5 (almost always).
In collaboration with the community advisory board, the A-COPE was slightly mod-
ied to include types of coping that were emerging in practice. Two questions were
added that included: “I go online and search the Internet; I go online to complain to my
friends.” In addition, the coping strategy of “Eat food” was moved from the subscale
of “Relaxing”to“Avoi ding P robl e ms”duetotheprevalenceofLGBTQ+youth eating
disordersreportedbythecommunityadvisoryboard.Forthisstudy,theA-COPE
overall had sucient internal consistency (Cronbach’s alpha =.87).
Data analyses
Missing data were examined for “missing at random” using the missing values anal-
ysis in SPSS. Data ranged from 0 to 3% missing on the A-COPE. The analytic plan
wascomprisedoftwosteps:(1)afrequencyanalysiswasconductedtoidentifycop-
ing patterns; and (2) a dependent sample t-test to identify any changes in participant
coping.
Results
Coping strategies
Participants utilized a range of coping strategies, as illustrated in Tab l e 2 .Among
all types of coping, avoiding problems was reported as the most frequent strategy

JOURNAL OF GAY & LESBIAN MENTAL HEALTH 27
Tab le  . Means of A-COPE scale.
Subscale mean Item mean (–) SE mean
Disengagement Coping
Avoiding problems (7 items) .
Smoke . .
Drink beer, wine, liquor . .
Use drugs (not prescribed by a doctor) . .
Tell yourself that the problem is not important . .
Trytostayawayfromhomeasmuchaspossible . .
Eat food . .
Engagement Coping—Primary Control
Developing social support (6 items) .
Apologize to people . .
Talk to a friend about how you feel . .
Try to help other people solve their problems . .
Try to keep up friendships or make new friends . .
Say nice things to others . .
Cry . .
Developing self-reliance and optimism (7
items)
.
Try to make your own decisions . .
Try to deal with it on your own . .
Organize your life and what you have to do . .
Go online to find answers or help∗. .
Try to see the good things in difficult situations . .
Try to think of good things in your life . .
Get a job or work harder at one . .
Investing in close friends (2 items) .
Be close with someone you care about . .
Be with a partner . .
Solving family problems (6 items) .
Go along with parents’request and rules . .
Try to reason with parents and talk things out;
compromise
. .
Talk to your mother about what bothers you . .
Talk to a brother/sister about how you feel . .
Do things with your family . .
Talk to your father about what bothers you . .
Seeking professional support (2 items) .
Get professional counseling (not from school) . .
Talk to a teacher or a counselor at school about
what bothers you
. .
Seeking spiritual support (2 items) .
Meditate or pray . . 
Talk to a minister/priest/rabbi . .
Engagement Coping—Secondary Control
Being humorous (2 items) .
Try to be funny and make light of it all . .
Joke and keep sense of humor . .
Relaxing (3 items) .
Listen to music—stereo, radio, etc. . .
Daydream about how you would want things to be . .
Ride around in the car . .
Ventilating feelings (7 items) .
Get angry and yell at people . .
Say mean things to people; be sarcastic . .
Go online and complain to your friends∗. .
Let off steam by complaining to your friends . .
Swear . .
Let off steam by complaining to family . .
(continued on next page)

28 S. L. CRAIG ET AL.
Tab le  . Continued.
Subscale mean Item mean (–) SE mean
Seeking diversion (8 items) .
Sleep . .
Work on a hobby . .
Read . .
Play video games . .
Watch T V . .
Go to a movie . .
Go shopping: buy things you like . .
Use drugs prescribed by doctor . .
Engaging in demanding activities (4 items) .
Try to improve yourself (get in shape, get better
grades, etc.)
. .
Work out (jogging, biking, etc.) . .
Work hard on schoolwork or other school projects . .
Get more involved in activities at school . .
Note. ∗denotes a new item.
(M =4.75), followed by being humorous (M =3.73), ventilating feelings (M=3.50),
developing social support (M =3.31), and investing in close friends (M =3.20).
Seeking professional (M =2.34) and spiritual (M =1.79) support were the least
used coping approaches. Specic items that were reported most frequently include:
listen to music (M =4.33); apologize to people (M =4.09); and joke and keep sense
of humor (M =3.90). The least utilized coping strategies included: talk to a minis-
ter/priest/rabbi (M =1.21); talk to your father about what bothers you (M =1.39);
and use drugs prescribed by doctor (M =1.76).
AFFIRM coping intervention eects
As evident in Table 3, there was a statistically signicant increase in the participants’
use of engagement coping post-intervention. Specically, dependent sample t-test
indicated signicant increases in the areas of primary control (solving family prob-
lems, t=2.70, p<0.01) and secondary control [seeking diversion (t=4.18, p<
0.001); engaging in demanding activities (t=2.51, p<0.05), and being humorous
(t=2.51, p<0.05) and seeking spiritual support (t=2.09, p<0.05)].
Discussion
This study contributes to the burgeoning research on the coping strategies uti-
lized by LGBTQ+youth. The ndings indicate that the AFFIRM intervention
shows promise to promote engagement coping and reduce reliance on less eective
strategies associated with disengagement coping. Moreover, ndings from this study
elucidate the coping experiences of LGBTQ+youth. Importantly, results on the A-
COPE from both pre- and post-test indicate that LGBTQ+youth rely on a wide
rangeofcopingstrategies.
Firstly, among all types of coping, “avoiding problems” as disengagement coping
appears to be the most frequently utilized strategy. Specically, this study indicated
disengagement coping (i.e., avoiding problems or using substances) as a common

JOURNAL OF GAY & LESBIAN MENTAL HEALTH 29
Tab le  . Dependent-sample T-test of A-COPE scale.
No. of Pre-test score Post-test score
Variables (number of items) Items Mean SD SE mean Mean SD SE mean t-value
Disengagement Coping
Avoiding problem  . . . . . . −.
Engagement Coping—Primary
Control
Solving family problems  . . . . . . .∗∗
Seeking professional support  . . . . . . .
Developing self-reliance and
optimism
 . . . . . . .
Developing social support  . . . . . . .
Seeking spiritual support   . . . . . .∗
Investing in close friends  . . . . . . .
Engagement Coping—Secondary
Control
Ventilating feelings  . . . . . . .
Seeking diversion  . . . . . . .∗∗∗
Engaging in demanding
activities
 . . . . . . .∗
Being humorous  . . . . . . .∗
Relaxing  . . . . . . .
Total Coping Score . . . . . . .∗∗∗
Note. ∗p<., ∗∗p<., ∗∗∗ p<..
coping strategy utilized by LGBTQ+youth, and there was no signicant change
post-intervention. It is important to consider the unique minority stressors and
social, familial, and cultural contexts of LGBTQ+youth when drawing conclusions
about the utility of the specic strategies of LGBTQ+youth. It is possible that cer-
tain avoidance strategies, such as keeping distance from prejudicial situations (e.g.,
staying away from homophobic peers or withdrawing from a stressful situation),
denying discriminatory experiences (e.g., redening hatred words to be unrelated to
sexual orientation), or wishful thinking (e.g., hoping someone will stand up against
the homophobic environment), may be eective for coping during adolescence as
youths’ hostile contexts (e.g., homo-/transphobic schools, families, communities)
maybeunlikelytochangeintheshortrun.
Our ndings about coping through the use of substances is consistent with exis-
tent research that has noted that LGBTQ+youth frequently utilize substances when
under stress (Austin & Craig, 2013;Marshalletal.,2008). As such, it may be partic-
ularly important to tune into the role of minority stressors in the lives of LGBTQ+
youth with substance use issues. Moreover, LGBTQ+with high levels of stress may
need targeted interventions which help them to identify coping strategies to replace
substance use as a way to cope with their painful emotions and often less than opti-
mal circumstances.
Participants also utilized a host of engagement strategies. Compared to the
nding in McDavitt et al.’s (2008)studythatLGBTQ+youth shy away from involve-
ment in family issues, our participants utilized the primary control coping strat-
egy of solving family problems. This includes following parents’ requests and rules
while also trying to reason with them and seek compromise. The LGBTQ+youth

30 S. L. CRAIG ET AL.
in this study communicated more with their mothers and siblings than their fathers
to solve family problems (Green, 2000;Savin-Williams,2003). Similarly, emerging
research has found that for some ethnoracial lesbian and bisexual girls, educating
their family members about LGBT issues is a source of resilience and coping (Craig,
Austin, Alessi, McInroy, & Keane, 2017). Therefore, interventions aimed to enhance
LGBTQ+youth resilience should not regard LGBTQ+youthonlyaspassivevic-
tims in their families, but rather support LGBTQ+in their eorts to advocate for
themselves within their families as a healthy coping strategy (Mallon, 2005).
LGBTQ+youth also utilized the secondary control coping strategies of seeking
diversion, engaging in demanding activities, and being humorous. Seeking diversion
is commonly utilized by adolescents in the face of stress (de Anda et al., 1997). In
this study, sleeping and working on a hobby were frequently utilized by LGBTQ+
youth. Engaging in demanding activities, such as trying to improve yourself and
organize your life and what you need to do, is a way to cognitively engage in being
resilient. Humor stands out as another prominent secondary control coping strat-
egy that LGBTQ+youth employ. This nding is consistent with results from adult
research;specically,astudyof214gaymenfoundthattheyrelyonhumortoget
through dicult situations (Christman, 2012). Humor may be particularly useful
for LGBTQ+youth faced with cumulative stress, as Abel (2002) found that adoles-
cents who have greater sense of humor report lower levels of stress, less anxiety, and
greater use of positive appraisal and problem-solving coping strategies.
In this study, many aspects of engagement coping (e.g., developing self-reliance
and optimism, ventilating feelings, and relaxing) tap into emotion regulation; these
ndings make sense, given the key role of emotional regulation in healthy adoles-
cent adjustment (Silk, Steinberg, & Morris, 2003). Emotion regulation, according to
Thompson (1994), is dened as a process where an individual understands, eval-
uates, and modies emotional responses under a stressful circumstance. Emotion
regulation decit, such as poor emotion awareness and excessive rumination, has
been identied as a determinant of poor adolescent mental health (Cicchetti & Toth,
2005;Silketal.,2003). Hatzenbuehler et al. (2008)foundthatforLGBTQ+youth,
emotion regulation decit can function as a mediator between minority stressors
and internalizing symptomatology and contribute to psychological distress.
Importantly, the engagement coping of AFFIRM participants increased from pre-
to post-intervention. Stated in another way, LGBTQ+developed more produc-
tive coping strategies to deal with identity-related stress through participation in
AFFIRM. In particular, AFFIRM appears to increase the primary control engage-
ment coping strategy of solving family problems and secondary control coping strate-
gies, which included seeking diversion, engaging in demanding activities,andbeing
humorous. Similarly, Steinhardt and Dolbier (2008)foundthataCBTinterven-
tion promoted resilience, problem solving, and positive reframing, and reduced the
avoidant coping and psychological symptoms of college students. Frydenberg et al.
(2004) also found that helping youth think concretely about their coping mecha-
nisms allows them to incorporate new approaches to managing stress. Existing evi-
dence (Austin & Craig, 2015b; Gordon, Tonge, & Melvin, 2011)alsosupportsthe
potential of using a CBT-based approach to arm LGBTQ+identities which may

JOURNAL OF GAY & LESBIAN MENTAL HEALTH 31
be an important component of mobilizing engagement coping skills. Further, nd-
ings of the present study note the potential importance of targeting coping as an out-
come variable within interventions designed to reduce psychological distress among
LGBTQ+youth.
It is essential to contextualize these emergent ndings with those coping strategies
reported less frequently. Participants reported low levels of seeking professional or
spiritual support. This is consistent with research conducted by Burgess et al. (2008),
who found that LGBTQ+youth do not use formal counseling services because
of real and/or perceived experiences of homophobic discrimination within social
service and mental health systems. A lack of relevant, accessible, and LGBTQ+
armative programs may be related to the underutilization of professional sup-
port by LGBTQ+youth (Gridley et al., 2016; Richardson, Stallard, & Velleman,
2010). Understanding and subsequently targeting the types of coping that LGBTQ+
youth utilize and tailoring services to meet their needs may enhance mental health
outcomes.
Limitations
This pilot study had several limitations. Given the small sample size and lack of
comparison group, research ndings should be interpreted with caution. The small
numbers may restrict the statistical power of this study in detecting meaningful dif-
ferences between pre- and post-intervention scores. Evaluating outcomes using a
randomized control trial with multiple follow-up periods in future research would
enable researchers to examine long-term treatment eects between LGBTQ+iden-
tities. Further studies should also use a variety of coping measures as outcomes.
Despite these challenges, this pilot study illuminates some commonly used cop-
ing strategies by LGBTQ+youth.Whileouranalysisfoundthepost-intervention
increase in participants’ being humorous, future studies may explore the frequency
and nature of the humor coping response for LGBTQ+youth. Understanding the
stressors and resultant coping strategies could enable services that enhance the cop-
ing toolbox of LGBTQ+youth and contribute to their resilience.
Conclusions and clinical implications
This study provides valuable insight regarding coping strategies employed by
LGBTQ+and the positive impact of a coping skills group intervention on youths’
coping approaches. Findings from this study provide valuable insight for clinicians.
The impact of minority stress on the lives of LGBTQ+necessitates a focus on
enhancing and building coping skills throughout clinical interactions. Clinicians
should utilize a comprehensive approach to understand and aid the development
of a range of coping strategies for LGBTQ+youth that is grounded in their daily
realities. The post-intervention increases in engagement coping suggest that CBT-
based coping interventions may have particular promise to impact active coping
strategies such as problem solving and self-improvement. Integrating clinical
approaches that encourage LGBTQ+youth to reect on their abilities to solve

32 S. L. CRAIG ET AL.
problems and manage stress eectively while arming the utility of the use of
humor to buer the eects of stress is an important consideration with this pop-
ulation. Such a tangible approach allows youth to evaluate their present coping
strategies and “test out” new skills. The results of this study underscore the impor-
tance of clinical practice and research focused on understanding and enhancing
coping among LGBTQ+youth.
Acknowledgments
The authors thank the thoughtful members of the AFFIRM Council Community Advisory Board
for their support and advice, Sandra D’Souza for brilliant data support, and the inspirational
youth who participated in this study.
Funding
This work was supported by the Institute of Infection and Immunity (Grant ID 72045249).
Disclosure
The authors have no conicts of interest to report.
ORCID
Shelley L. Craig, PhD, LCSW http://orcid.org/0000-0002-7991-7764
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